UHC need help with appeal

I was denied for surgery because I did not meet the 5 year history criteria.  5 years ago today I had a BMI of 33.5 and no co-morbidities.  Today my BMI is 41 and I have 4 co-morbities (anxiety, if that counts, Hypertension, high cholesterol and arthritis)  Is ther any way to get this appealed based on my current health??? Thanks for any help. Sherri

Don't give up, fight.  NIH guidelines is 35 so you meet those guidelines.  Make sure you fight on that basis.

All you need is one weight for each year where your BMI was above 35, so find it! You do not have to e above 35 for each and every day of the last 5 years, only one weight per year. Call your OB or any other doc you saw and review your weights. Pick out the very heaviest weight for your appeal. My office has won this fight this way for our patients. I type in the letter for appeal, "as you can see Jane's weight was xxx in January of 2004 with a BMI of 36. SHe has attempted to lose weight on many occasions and was dieting during June when her weight was xxx" which explains the discrepancies. You will be ok, just find those records! They will not pay if you cannot find the weight history they require, believe me. Yes, you meet the criteria now, and they are not saying you cannot have surgery, they are just saying they will nto pay for it unless you have been ovese for 5 years, so show 'em!

 

Bonnie